• Annals of Clinical Neurophysiology
• /
• 제17권2호
• /
• pp.91-94
• /
• 2015

The adverse effects of systemic steroid medications are well known, whereas those of local steroid injections are unclear even to clinicians. We report two cases of localized lipoatrophy and depigmentation following local steroid injection. Although the incidence of soft tissue atrophy after local steroid injection is rare, it will increase in proportion to the frequency of the procedure. All clinicians, even those who do not perform steroid injections, should be aware of the occurrence of this cosmetically disturbing adverse effect.

• 대한족부족관절학회지
• /
• 제8권2호
• /
• pp.218-220
• /
• 2004

It is known that steroids increase the risk for tendon ruptures. Despite this local steroids are still used in the treatment of achilles tendinitis. 46-year-old women had occurred achilles tendon rupture after repeated local steroid injection. Intraoperatively, necrotic change were seen at both side of ruptured end. Like this, tendon rupture after repeated steroid injection often result in a large defect, which needed surgical repair. After debridement of ruptured end, tenorrhaphy with single Krackow method and plantaris tendon augmentation was done. The patient showed favorable result with return to range in a degree of activity levels.

• Archives of Plastic Surgery
• /
• 제33권1호
• /
• pp.120-123
• /
• 2006

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

• Annals of Clinical Neurophysiology
• /
• 제15권1호
• /
• pp.7-12
• /
• 2013

Background: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period. Methods: Twenty-one patients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment. Results: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months. Conclusions: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.

• 대한족부족관절학회지
• /
• 제17권4호
• /
• pp.309-315
• /
• 2013

Purpose: The purpose of the study was to investigate five cases with chronic Achilles tendon rupture that occurred after steroid injections. Materials and Methods: In our hospital, we experienced five cases of chronic Achilles tendon rupture from September 2010 to March 2012. All patients had got steroid injection for Achilles tendinitis at the other hospitals, and their heel pain was aggravated when they visited our outpatient department. After treatment, signs and symptoms of Achilles tendon rupture were developed and the diagnosis was confirmed by ultrasonography or magnetic resonance imaging (MRI). Surgical treatment was done for Achilles tendon rupture. Results: There was difference between intra-operative findings of Achilles tendon rupture and usual chronic Achilles tendon rupture. Unlike usual findings of chronic Achilles tendon rupture whose scar tissue or tissue attenuation are found around the defect area of Achilles tendon, there were partial necrosis of tendon severe adhesion with surrounding tissue, extensive defect and longitudinal rupture on ruptured area. Also, severe inflammation of paratenon, granulation and fibrinoid deposit were found on biopsy findings in four cases. Conclusion: Based on review of data about relative risk and benefit of local corticosteroid injection to inflammatory lesion in Achilles tendon, it requires more attention to Achilles tendon rupture following local corticosteroid injection.

• The Korean Journal of Pain
• /
• 제9권1호
• /
• pp.98-101
• /
• 1996

Background: Lumbar epidural steroid injection for relief of low back pain and sciatica has become a popular procedure. further, cervical epidural steroid injection with nerve block (CESNB) is known to be effective for the management of acute and chronic pain of neck, shoulder and arm. However, many anesthesiologists are not familiar with CESNB. Methods: Charts of 34 patients who had undergone 60 cervical epidural steroid injections over a three year period, 1993 to 1995, were reviewed. We studied the followings: initial visit and department, injected interspaces, personal characteristics, indications for injection and complications. Results: Patients' first visits were mainly to orthopaedics (11 patients) and neurosurgery (10 patients). Epidural injection sites were: C7-T1 interspace (29 patients) and C6-C7 interspace (6 patients). Mean age of patients were 50.1 years. range 21~73 years. There were twenty male and fourteen female patients. Complications varied from dizziness after CESNB (1 patient). loss of consciousness with transient apnea (2 patients), and local infection with suspicious meningitis (1 patient). Conclusion: We conclude from the above data that CESNB is a good, safe and conservative form of therapeutic procedure in the management of patients suffering from cervical radiculopathy, and neck and shoulder pain.

• Clinics in Shoulder and Elbow
• /
• 제1권1호
• /
• pp.35-39
• /
• 1998

From May 1994 to May 1995, we performed a prospective controlled double-blind clinical study of 85 patients(85 shoulders). For inclusion in the study all patients met the following criteria: 1) a diagnosis of impingement syndrome by lidocaine injection test; 2) symptoms for at least three months; 3) no previous subacromial injection; 4) no evidence of rotator cuff tear. We excluded the patients from the study who showed a instability or other clear primary cause. The patients were randomized to receive either 5/subcc/ 2% lidocaine with 4ee of 20mg/cc Depomedrol(Group 1) in 45 cases or 5/subcc/ 2% lidocaine solely(Group 2) in 40 cases. At three month follow-up, all results were better in steroid group than control group. But at one year, improvement of pain and daily activity showed no difference between two groups. So we conclude that the use of subacromial steroid injection is effective for short-term therapy in the treatment of subacromial impingement syndrome, but the long-term effectiveness is doubtful.

• The Korean Journal of Pain
• /
• 제3권2호
• /
• pp.150-159
• /
• 1990

The patient with muscle contraction headache usually have one or more specific trigger points. These trigger points have been treated with various treatment modalities including "stretch and spray" and regional infiltration with local anesthetics with or without corticosteroids. I treated 36 patients with muscle contraction headache with regional infiltration of local anesthetics and steroid into trigger points and the results were as follows 1) The diagnosis of muscle contraction headache was possible by confirming specific trigger points by palpation. 2) Patients relieved rapidly from headache by regional infiltration of local anesthetics and steroid into the tender point. 3) Single injection was effective in relieving headache. But the curability of the single injection could not be assessed because of difficulty in follow-up study. 4) Active trigger points could be occasionally inactive, which also made difficult in assessing the effectiveness of the treatment.

• 대한정형외과 초음파학회지
• /
• 제8권1호
• /
• pp.1-5
• /
• 2015

목적: 본 연구는 수평 내전 검사로 인해 견관절 후방부 동통의 악화를 보이는 환자에 대해서 초음파 유도 하에 스테로이드를 이용한 극하근 주사 치료 후 그 유용성에 대하여 평가하고자 하였다. 대상 및 방법: 2013년 5월부터 2014년 5월까지 견관절 후방부 통증을 주소로 내원한 환자 중 수평 내전 검사 시 동통의 악화를 보이는 21명을 대상으로 하였다. 외래에서 초음파 유도하에 극하근에 스테로이드 주사 치료를 시행하였으며 시술 전, 시술 후 3개월, 6개월로 나누어 VAS 통증 점수, UCLA 점수를 평가하였다. 결과: 스테로이드를 이용한 극하근 주사 치료 3개월 경과 시 환자들의 VAS 점수, UCLA 점수에서 임상적으로 유의하게 향상되었다(p<0.05). 시술 후 3개월과 6개월을 비교하면 VAS 점수와 UCLA 점수는 유의한 차이는 없었다(p>0.05). 6개월 추시 후 증상의 호전이 있는 완쾌 및 호전은 14예(67%)이었고, 호전이 없는 비호전 및 악화는 7예(33%)이었다. 결론: 초음파 유도 하에 스테로이드를 이용한 극하근 주사요법은 견관절 후방 통증이 있으며 수평 내전 시 통증이 악화되는 증상이 있는 환자들에게 유용한 시술이라고 생각된다.

• The Korean Journal of Pain
• /
• 제23권4호
• /
• pp.254-257
• /
• 2010

Background: Epidural steroid injection is an established treatment modality for intervertebral disc prolapse to radiculopathy. In cases where two levels of radiculopathy are present, two separate injections are warranted. Herein, we present our experience of management of such cases with a single epidural injection of local anaesthetic, tramadol and methylprednisolone, and table tilt for management of both radiculopathies. Methods: 50 patients of either sex aged between 35-65 years presenting with features of cervical and lumbar radiculopathic pain were included and were subjected to single lumbar epidural injection of local anaesthetic, tramadol and methylprednisolone, in the lateral position. The table was then tilted in the trendelberg position with a tilt of 25 degrees, and patients were maintained for 10 minuted before being turned supine. All patients were administered 3 such injections with an interval of 2 weeks between subsequent injections, and pain relief was assessed with a visual analogue scale. Immediate complications after the block were assessed. Results: Immediate and post procedural complications observed were nausea and vomiting (20%), painful injection site (4%), hypotension (10%) and high block (4%). Pain relief was assessed after the three injections by three grades: 37 (74%) had complete resolution of symptoms; 18% had partial relief and 8% did not benefit from the procedure. Conclusions: This technique may be used as an alternative technique for pain relief in patients with unilateral cervical and lumbar radiculopathies.